NCI and University of Alabama in Huntsville to Conduct Breast Cancer Study,
Offer Screening Exams in Triana, Ala.

The National Cancer Institute (NCI) and the University of Alabama in Huntsville (UAH) College of Nursing will conduct a study of the possible relationship between exposure to the pesticide DDT and risk for breast cancer and benign (non-cancerous) breast conditions among women in Triana, Ala., a town in northern Alabama on the Tennessee River.

The project targets women who are members of the Triana Area Medical Fund, Inc., which provides health care and health monitoring for the community. It will be locally managed by Fay Raines, Ph.D., professor and dean of the College of Nursing, and Jane Cash, Ph.D., associate professor.

Women in the Triana community will be offered breast cancer screening and a standard blood chemistry analysis as might be provided during a periodic medical checkup.

The study will be kicked off with an open house and health fair for the community on the afternoon of Sunday, Feb. 15, 1998 at the Triana Community Center.

"The Triana Community Health Initiative provides a unique opportunity to investigate DDT and breast health in a population with a history of very heavy exposure to the pesticide," said
Susan Sieber, Ph.D., deputy director of NCI's Division of Cancer Epidemiology and Genetics. She noted the study will investigate not only breast cancer, but also benign breast disease and mammographic densities (breast tissue densities) -- conditions that may increase risk of breast cancer and that have not been explored in other studies of DDT.

Presently, there is no evidence that the women from Triana and surrounding counties have more breast cancer or benign breast conditions than women of the same age and race who live in other areas of the United States, said Raines. However, she added, the Triana population, with high levels of exposure to DDT, has not been specifically studied.

DDT was banned in the United States in the early 1970s, but because it is ubiquitous in the food chain and has a long half life, residues still persist in the environment. In recent years, the pesticide, which is stored in human fat and is released slowly, has been detected in human breast tissue and breast milk. Further, the pesticide has been found to cause tumors in laboratory animals. These observations have prompted epidemiologic (human populations) studies to investigate whether the pesticide is associated with risk for breast cancer in humans.

Also in the early 1970s, body burdens of DDT were found to be an average of 10 times higher in the Triana population than in the general U.S. population. The people consumed DDT-contaminated fish from neighboring tributaries of the Tennessee River into which the pesticide had been discharged from a nearby DDT production plant. The settlement of lawsuits led to the establishment of the Triana Area Medical Fund, Inc. The Triana Community Health Initiative is not part of the Fund's activities, although the study has the support of its Trustees and draws on its members for study participation.

Women, age 35 and older, will receive a physical breast examination by a health professional and a mammogram (X-ray of the breast). They will also be asked to provide a blood sample and to answer a short questionnaire about their health and known risk factors for breast cancer, such as their age, age at first birth, and age at start of menstruation and menopause. Women who are found to have breast abnormalities will be referred to area medical facilities for follow-up care. Interviews and arrangements for the breast exams will be made by the UAH College of Nursing.

"We are delighted to have another opportunity to work on a health project with the people of Triana," said Raines. "The community, members of the Triana Area Medical Fund, and the Triana Town Council have been most supportive, and a community advisory group of Triana women has already been established to help with the study."

After the breast exams and interviews are completed, the researchers will evaluate DDT and DDE ( a metabolite of DDT) levels in the blood of women who have been found to have breast cancer, benign breast conditions, or dense breast tissue, with those from women in the community without these conditions. Certain benign breast diseases, such as atypical hyperplasia, are known to increase risk for development of breast cancer. Moreover, there is mounting scientific evidence that dense breast mammographic patterns may be an indicator of increased risk for the cancer in some women. Greater understanding of characteristics of breast tissue that signal increased risk for cancer will help researchers and health care professionals identify those women who need to be followed carefully. When detected and treated early, breast cancer is highly curable. In addition, identifying women at high risk will be important as strategies to prevent the cancer are developed.

The researchers will also compare current blood levels of DDT with stored blood samples which were taken from many of the same women in 1979, so that changes in body burden levels of DDT over the years can be charted and characterized. Further, information will be analyzed on past cases of breast cancer and risk factors of the cancer obtained from two medical surveys conducted by the Triana Area Medical Fund, Inc., over the past decade.

Results of each participant's breast cancer screening and blood analysis will be provided to them, or if they wish, to their health care providers. Otherwise, individually identifying information will be kept confidential. Findings from the full study will be reported to the Triana Community when the study is completed in 1999.

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